I'm in a delivery with terminal bradycardia and yucky decels. Nursery nurse is standing by and I have my labor nurse at the bedside with me. The patient, who speaks no English, is pushing well and delivery will occur before I can get a doc there to vacuum. The head is crowning, the nurse asks me if I will cut an epis to hasten delivery (and this isn't the retard moment). I say no and instead do minimal Ritgen's maneuver.
Head delivers with loop of cord hanging out.
The head is big.
The patient is very small.
I tell the nurse to pull the emergency call light to get some extra help. She then prepares to do suprapubic pressure and McRoberts all by herself as I can tell it will be a tight fit.
Over the intercom "Can I help you?"
Huh? The normal response when the emergency call light goes off is no one answers it...cause nurses are busy rushing into the room.
I say "We need help in here"
"Who would you like?"
Please shoot me now. What the f*** is going on?
I say "nurses"
No one ever comes. So I am totally pissed off and wondering what the hell happened. Fortunately the nurse and I managed the shoulder dystocia, which was mild, and had a good outcome.
Turns out that someone on the postpartum unit answered the call light and never bothered to call back to L&D to let them know or check if there was a problem.
Lovely. Postpartum was told not to answer L&D call lights ever again.
Oh, the patient delivered over an intact perineum - 8 pound baby and her first as well.
Wednesday, December 31, 2008
Catch-up
I hope everyone has been enjoying their holidays - Happy New Year's!
We had a great Christmas, lots of family time. Very relaxing just sitting around the fireplace, playing Wii, etc. Christmas dinner, courtesy of my husband, was excellent!
I was on call yesterday and aside from being very busy in the office, it was pretty laid back. I had a Burmese lady who I had never met that came in and had her baby in the late morning. It's really so frustrating when there is a language barrier. It becomes very difficult to make a connection with someone. It really makes me realize how important language is to us. At least with hispanic women I can speak a few words.
Aggravating things in the office this past couple weeks...
1. On Monday I saw at least 6 pregnant women who were dehydrated. Drink ladies drink!
2. Yesterday, the trend of the day was spotting/bleeding in the first trimester. One lady went to the hospital the weekend before Christmas, when she was about 12 weeks. She went even though the midwife on call advised her to stay home and wait until Monday unless, of course, worsening of symptoms occurred. Well, the patient tells me it wasn't convinient (I never can get the spelling right on this word) since she had to work Monday and she just wanted some piece of mind. What she wanted was an ultrasound! The hospital did this whole work up and everything was completely normal. Go figure. As I listened to her talk about it was easier to go to the hospital then wait and come to our office a day later, I kept thinking "well, it's not easier when I have to pay the bill for people who take advantage of their free medical care". Grrr....I once had a patient tell me, when I was a L&D nurse, after I said that I wanted to get the last little bit out of her IV bag..."oh, that's no big deal, I don't have to pay for it anyway". I actually told her "well I do" but I don't think she got it.
3. Spotting on and off for four days at 6 weeks pregnant....a family member asks for an ultrasound.....um, no.
Anyway, that's enough being snarky....these things sometimes get frustrating though. Plus, it's a really bad time of the month this month for me with PMDD. I've got one nerve left and everyone wants to step on it!!!!
I'm off for the next five days so plan to get some stuff done around the house, chill, watch movies, and of course, catch up on blogging!
We had a great Christmas, lots of family time. Very relaxing just sitting around the fireplace, playing Wii, etc. Christmas dinner, courtesy of my husband, was excellent!
I was on call yesterday and aside from being very busy in the office, it was pretty laid back. I had a Burmese lady who I had never met that came in and had her baby in the late morning. It's really so frustrating when there is a language barrier. It becomes very difficult to make a connection with someone. It really makes me realize how important language is to us. At least with hispanic women I can speak a few words.
Aggravating things in the office this past couple weeks...
1. On Monday I saw at least 6 pregnant women who were dehydrated. Drink ladies drink!
2. Yesterday, the trend of the day was spotting/bleeding in the first trimester. One lady went to the hospital the weekend before Christmas, when she was about 12 weeks. She went even though the midwife on call advised her to stay home and wait until Monday unless, of course, worsening of symptoms occurred. Well, the patient tells me it wasn't convinient (I never can get the spelling right on this word) since she had to work Monday and she just wanted some piece of mind. What she wanted was an ultrasound! The hospital did this whole work up and everything was completely normal. Go figure. As I listened to her talk about it was easier to go to the hospital then wait and come to our office a day later, I kept thinking "well, it's not easier when I have to pay the bill for people who take advantage of their free medical care". Grrr....I once had a patient tell me, when I was a L&D nurse, after I said that I wanted to get the last little bit out of her IV bag..."oh, that's no big deal, I don't have to pay for it anyway". I actually told her "well I do" but I don't think she got it.
3. Spotting on and off for four days at 6 weeks pregnant....a family member asks for an ultrasound.....um, no.
Anyway, that's enough being snarky....these things sometimes get frustrating though. Plus, it's a really bad time of the month this month for me with PMDD. I've got one nerve left and everyone wants to step on it!!!!
I'm off for the next five days so plan to get some stuff done around the house, chill, watch movies, and of course, catch up on blogging!
Monday, December 15, 2008
The weekend
The weekend on call was not too bad. I had three babies and those were all convinently (sp) during the day. I spent my nights at home in my own bed. I even got to go to the office Christmas party.
One thing of note...
About midnight last night, just as I had fallen asleep, I got another call from the triage nurse at the hospital. Apparently the doctor on call for the weekend (from another practice) had asked her to see if I would come in for a delivery on a doctor patient that had just come in and gone from 4 cms to 6 cms while in triage.
Uh....no.
I like this doctor and have caught babies for her in the past so she wouldn't need to come in....but that was when I was already there! I'm not getting out of my warm bed in the middle of the night for a doctor patient whom I have never met!
I had dental work done this morning - oh joy. But damn that nitrous oxide is good stuff!
One thing of note...
About midnight last night, just as I had fallen asleep, I got another call from the triage nurse at the hospital. Apparently the doctor on call for the weekend (from another practice) had asked her to see if I would come in for a delivery on a doctor patient that had just come in and gone from 4 cms to 6 cms while in triage.
Uh....no.
I like this doctor and have caught babies for her in the past so she wouldn't need to come in....but that was when I was already there! I'm not getting out of my warm bed in the middle of the night for a doctor patient whom I have never met!
I had dental work done this morning - oh joy. But damn that nitrous oxide is good stuff!
Friday, December 12, 2008
Lack of writing
I haven't been blogging much - just very tired and a wee bit overwhelmed with holiday stuff. So I have given myself permission to blog only when I feel like it :) Things may be a bit slow over the next couple weeks in that case.
Vegas was fabulous fun but we made a deposit instead of a withdrawal :p I discovered single-deck blackjack and loved it. I actually made some of our losses back playing that. The odds are supposed to be better anyway with single deck.
Work is busy busy - haven't been on call since before leaving for Vegas but start call tonight until Monday morning. My first weekend....I'm a little nervous.
I'm having a hard time in the office with some of my ladies - there are several that I have been seeing almost exclusively and feel so very bonded with. So then I am telling them I will try to be there for their delivery. I shouldn't be doing this so much though - it can take up a lot of personal time and my girls are always disappointed when I have to leave for a baby :( I feel very torn.
Vegas was fabulous fun but we made a deposit instead of a withdrawal :p I discovered single-deck blackjack and loved it. I actually made some of our losses back playing that. The odds are supposed to be better anyway with single deck.
Work is busy busy - haven't been on call since before leaving for Vegas but start call tonight until Monday morning. My first weekend....I'm a little nervous.
I'm having a hard time in the office with some of my ladies - there are several that I have been seeing almost exclusively and feel so very bonded with. So then I am telling them I will try to be there for their delivery. I shouldn't be doing this so much though - it can take up a lot of personal time and my girls are always disappointed when I have to leave for a baby :( I feel very torn.
Saturday, December 6, 2008
Busy busy busy
Been busy around here...
I missed three of four deliveries this past week! #1 came in complete and pushing (and it was her 6th baby - she had her legs crossed when she came up in the wheelchair...or so the nurse told me :) #2 happened as I was coming out of the OR from first assisting. I missed #3 by half a minute - got stuck in traffic due to an accident between the hospital and my office (and she came in 9cm, second baby). *sigh*
Finally finished decorating for Christmas today and am exhausted.
We leave for Vegas tomorrow (my husband and I) for a couple nights so will catch up more later in the week!
Oh, and read a couple good books I would recommend if you like to read memoirs.
Playing Catch by Sarah Urang - totally my type of personality, funny, irreverent, check it out!
A Midwife's Story by Penny Armstrong, etc - I love reading about the Amish culture/lifestyle. I came close to taking a job in this area - it's absolutely gorgeous!
Currently reading Brisngr...
I missed three of four deliveries this past week! #1 came in complete and pushing (and it was her 6th baby - she had her legs crossed when she came up in the wheelchair...or so the nurse told me :) #2 happened as I was coming out of the OR from first assisting. I missed #3 by half a minute - got stuck in traffic due to an accident between the hospital and my office (and she came in 9cm, second baby). *sigh*
Finally finished decorating for Christmas today and am exhausted.
We leave for Vegas tomorrow (my husband and I) for a couple nights so will catch up more later in the week!
Oh, and read a couple good books I would recommend if you like to read memoirs.
Playing Catch by Sarah Urang - totally my type of personality, funny, irreverent, check it out!
A Midwife's Story by Penny Armstrong, etc - I love reading about the Amish culture/lifestyle. I came close to taking a job in this area - it's absolutely gorgeous!
Currently reading Brisngr...
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